Can extended upper pole ureterectomy prevent ureteral stump syndrome after proximal approach for duplex kidneys?

Bruno Nicolino Cezarino,Francisco Tibor Dénes,Roberto Iglesias Lopes,Ricardo Haidar Berjeaut

doi:10.1590/s1677-5538.ibju.2020.0686

Bruno Nicolino Cezarino, Francisco Tibor Dénes + Show 2 more

Open Access

https://doi.org/10.1590/s1677-5538.ibju.2020.0686

Copy DOI

Abstract

ABSTRACTIntroduction:Symptomatic duplex kidneys usually present with recurrent urinary tract infection due to ureteral obstruction (megaureter, ureterocele or ectopic ureter) and/or vesicoureteral reflux. Upper-pole nephrectomy is a widely accepted procedure to correct symptomatic duplex systems with poor functioning moieties, also known as upper or proximal approach. The distal ureteral stump syndrome (DUSS) can be a late complication of this approach. There is no consensus upon the length of ureteral dissection and the better approach to symptomatic disease in duplex systems, so we aim to identify if extended ureteral dissection can prevent DUSS in top-down approach.Materials and Methods:Forty-four consecutive patients with symptomatic duplex system were retrospectively classified into two groups: those with limited ureteral excision after heminephrectomy (HN) (group-1) and those with extended ureterectomy after HN (group-2). Patients were followed-up for at least 36 months regarding outcomes of distal ureteral stump.Results:Overall complication was 20%. A total of 8 patients required unplanned further surgery in Group-1 (30%) whereas only 1 patient required unplanned surgery in group 2 (6%) (p=0.07). Subgroup analysis showed that Group-1 presented more DUSS requiring surgery during follow-up than group-2 (p=0.04). Factors possibly affecting complications incidence (such as ureterocele or ectopic ureter) did not differ between groups (p=0.72 and p=0.78).Conclusion:Upper pole nephrectomy should be performed with extended distal ureteral dissection to prevent ureteral stump complications.

Highlights

Symptomatic duplex kidneys usually present with recurrent urinary tract infection due to ureteral obstruction and/or vesicoureteral reflux
Symptomatic duplex kidneys usually present with recurrent urinary tract infection due to ureteral obstruction of the upper pole, megaureter, ureterocele or ectopic ureter, and/ or vesicoureteral reflux to the lower pole, eventually compromising affected moiety function [2, 3]
This study aims to identify if extended ureteral dissection can prevent distal ureteral stump syndrome (DUSS) in the upper or proximal approach

Summary

Introduction

Symptomatic duplex kidneys usually present with recurrent urinary tract infection due to ureteral obstruction (megaureter, ureterocele or ectopic ureter) and/or vesicoureteral reflux. Symptomatic duplex kidneys usually present with recurrent urinary tract infection due to ureteral obstruction of the upper pole, megaureter, ureterocele or ectopic ureter, and/ or vesicoureteral reflux to the lower pole, eventually compromising affected moiety function [2, 3]. Known as upper or proximal approaches, are usually performed by laparoscopic technique, with simple and straightforward techniques Another option is the lower or distal approach, which address directly the uretero-vesical junction (UVJ), whose main advantage is the more comprehensive correction of the anatomical abnormalities of both ureters, albeit with a significantly more invasive reconstructive surgery, which is prone to more complications [4]

Objectives

Methods

Results

Conclusion